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Federal Legislative Policy

PACE has a long history of bipartisan support among members of Congress committed to ensuring quality care is available to vulnerable individuals in our communities.

U.S. Senate Request for Information on Dually Eligible Beneficiaries

NPA Seeks Your Input on Our Comments for Senate RFI by Jan. 11

U.S. Sens. Bill Cassidy, MD (R-LA), Tom Carper (D-DE), Tim Scott (R-SC), Mark Warner (D-VA), John Cornyn (R-TX), and Robert Menendez (D-NJ) have joined together to explore ways to improve the quality of care received by beneficiaries eligible for both Medicare and Medicaid and decrease fragmentation. They have issued a Request for Information on this topic. NPA has assembled a response and welcomes your input on the draft by close of business on Wednesday, Jan. 11. We look forward to your thoughts. Please share your suggestions with Francesca Fierro O'Reilly, vice president of Advocacy. Thank you in advance for your consideration.

Pass the PACE Part D Choice Act

For more information, contact Francesca Fierro O’Reilly, vice president of Advocacy.

Elizabeth Dole VA Home and Community Based Services for Veterans and Caregivers Act of 2022

PACE Expanded Act of 2022

PACE Plus Act (S.1162), (H.R. 6770)

NPA Shares COVID-19 and Other Policy Priorities For PACE With Biden Transition Team

NPA sent a letter to President-Elect Biden’s Transition Team outlining our COVID-19 and access policy priorities. The  letter highlighted the efficacy of the PACE model of care during the COVID-19 pandemic and detailed our policy recommendations for increasing access to PACE. NPA looks forward to communicating further with the incoming White House and Department of Health and Human Services principals and staff to ensure they are aware of the notable value proposition PACE offers for participants, their families, state governments, the federal government and the American health care system overall. 

For more information, contact Francesca Fierro O’Reilly, vice president of Advocacy at NPA.

NPA Works to Protect PACE Organizations During COVID-19 Pandemic

NPA is working every day with regulatory, legislative and state policy staff as PACE organizations confront the COVID-19 pandemic. You can view this update of NPA congressional and regulatory activities, our COVID-19 congressional requests, and this NPA Brief Summary of Provisions of Interest to PACE from the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Act.  In June NPA sent a letter to Congressional leaders outlining our legislative priorities  during the pandemic.

NPA Responds to Request for Alzheimer’s Disease Policy Proposals

The U.S. Senate Finance Committee Subcommittee on Health recently requested information on policy solutions to enhance care for those living with Alzheimer’s disease and related dementias and their families. NPA was pleased to respond to this request, which was led by subcommittee chair Pat Toomey (R-PA) and ranking member Debbie Stabenow (D-MI), with our comments.

Prior to the COVID-19 outbreak, we understood that Sens. Toomey and Stabenow planned to review all the submitted ideas and work together on a wide-ranging legislative proposal. Given that Congress is solely focused on responding to COVID-19 needs, NPA does not expect any progress on this initiative in the near future. We will continue to monitor this effort and keep you informed.

For more information, contact Francesca Fierro O’Reilly, vice president of Advocacy.

Issue Brief: Part D Options for Medicare-Only PACE Participants

Participants in Programs of All-Inclusive Care for the Elderly (PACE®) are required to enroll in the Medicare Part D prescription drug plan offered by their PACE program rather than have the option to choose an alternative stand-alone Part D plan in the marketplace that might offer a more affordable alternative.

In a new issue brief on Part D Options for Medicare-Only PACE Participants, NPA recommends allowing Medicare-only PACE participants to choose between the current PACE Part D plan, with an all-inclusive premium and no deductible or co-insurance, and a marketplace Part D plan that has a lower premium and related deductible and co-insurance amounts.

Congressional Appropriators Urge CMS to Release Final PACE Rule

After Congress passed the 2019 Department of Defense and Labor, Health and Human Services, and Education Appropriations Act and 2019 Continuing Appropriations Act (HR 6157), the president signed the legislation into law on Sept. 28, 2018. The enactment of HR 6157 is significant to PACE because the report accompanying the final bill directs the Centers for Medicare & Medicaid Services (CMS) to release the final PACE rule.

Report language used by both the House and Senate Appropriations Committees provides specific direction to federal agencies beyond what is specified in the text of the appropriations legislation. Specifically, the report for HR 6157 states, “[T]he committee recognizes the value that the Program of All-Inclusive Care for the Elderly (PACE) provides for 45,000 Medicare and Medicaid beneficiaries who would otherwise require nursing home levels of care and are instead able to stay in their communities. The committee is aware that CMS has not yet finalized their update to the regulations governing the PACE program and encourages CMS to expeditiously publish the final rule for proposed changes for PACE [CMS-4168-P].”

NPA sincerely thanks Sen. Dianne Feinstein (D-CA), who championed the inclusion of this missive after hearing the concerns of CalPACE and its member organizations in an in-person meeting during the 2018 NPA Spring Policy Forum. We applaud her strong leadership and willingness to take action.

For more information, contact Francesca Fierro O’Reilly, vice president of Advocacy at NPA.

VA Consolidates Community Care Programs

On June 6, 2018, President Trump signed into law the VA Mission Act of 2018 (PL 115-182). This bill combined all existing U.S. Department of Veterans Affairs (VA) programs providing care to veterans outside the system into one, called the Veterans Community Care Program.

Based on an analysis by NPA, the new program will continue to permit veterans to enroll in PACE if they meet the specific criteria of the act, which include the following:

  • if the VA does not offer the care or services required by the veteran;
  • if the local VA does not meet quality standards;
  • if the veteran previously was eligible under the 40-mile rule of VA Choice (i.e., the veteran lives more than 40 miles from a VA medical facility); or
  • if the vereran’s clinician deems that receiving care in the community would be in the person’s best interest after considering distance the veteran has to travel for care, the nature and frequency of care required, the timeliness of the care, and if the veteran would face an “unusual or excessive” burden in seeking care.

The VA Mission Act gives permission for funds to be spent on the new Community Care program and specifies a target funding level but does not contain any funding, as is customary. The appropriations process will provide the funds to spend, and House-Senate negotiations are ongoing for fiscal year 2019.

NPA is seeking a meeting with the VA to discuss how the agency plans to implement the new Veterans Community Care Program. We will advocate for additional veterans to have access to PACE through the existing partnerships with local VA Medical Centers, in addition to the establishment of new partnerships.

For more information, contact Francesca Fierro O’Reilly, vice president of Advocacy.

Thank You for Contacting Your House Members

Sixty-nine members of the U.S. House of Representatives have signed a letter to CMS administrator Seema Verma urging CMS to release the final PACE rule and move ahead on the PACE pilots as quickly as possible. NPA thanks U.S. Reps. Chris Smith (R-NJ-4), Earl Blumenauer (D-OR-3), Lynn Jenkins (R-KS-2), and Ron Kind (D-WI-2) afor their leadership on this issue.

Visit our Take Action webpage to thank your U.S. representative for signing the letter by Reps. Smith, Blumenauer, Jenkins and Kind.

If you have any questions, contact Francesca Fierro O'Reilly, vice president of Advocacy.

U.S. Representatives Advocate for PACE in Letter to CMS

Because the Centers for Medicare & Medicaid Services (CMS) has not yet released the PACE final rule or moved forward on the PACE pilots as directed by the PACE Innovation Act of 2015, U.S. Reps. Chris Smith, Earl Blumenauer, Lynn Jenkins and Ron Kind asked their colleagues in the U.S. House of Representatives to sign onto a letter they were sending to CMS administrator Seema Verma urging CMS to release the final PACE rule and move ahead on the PACE pilots as quickly as possible.

NPA members used our Take Action webpage to ask their representatives to support PACE by signing onto the letter. On Nov. 6, 2017, a letter bearing 48 signatures of House members was sent to Verma.

NPA thanks all of our members who contacted their representatives.

We also thank the House members who acted on behalf of PACE: Alma Adams (D-NC-12), Gus M. Bilirakis (R-FL-12), Earl Blumenauer (D-OR-3), Michael E. Capuano (D-MA-7), André Carson (D-IN-7), Ryan Costello (R-PA-6), Joseph Crowley (D-NY-14), Carlos Curbelo (R-FL-26), Debbie Dingell (D-MI-12), Adriano Espaillat (D-NY-13), Ron Estes (R-KS-4), Brian Fitzpatrick (R-PA-8), John Garamendi (D-CA-3), Garret Graves (R-LA-6), Brian Higgins (D-NY-26), Lynn Jenkins (R-KS-2), John Katko (R-NY-24), Mike Kelly (R-PA-3), Ron Kind (D-WI-3), Leonard Lance (R-NJ-7), Jim Langevin (D-RI-2), Frank LoBiondo (R-NJ-2), Alan Lowenthal (D-CA-47), Michelle Lujan Grisham (D-NM-1), Doris O. Matsui (D-CA-16), James McGovern (D-MA-2), Patrick Meehan (R-PA-7), Seth Moulton (D-MA-6), Dan Newhouse (R-WA-4), Bill Pascrell, Jr. (D-NJ-9), Scott Peters (D-CA-52), Jim Renacci (R-OH-16), Ileana Ros-Lehtinen (R-FL-27), Keith Rothfus (R-PA-12), Lucille Roybal-Allard (D-CA-40), Linda Sánchez (D-CA-38), Jan Schakowsky (D-IL-9), Kurt Schrader (D-OR-5), Albio Sires (D-NJ-8), Chris Smith (R-NJ-4), Jackie Speier (D-CA-14), Eric Swalwell (D-CA-15), Paul D. Tonko (D-NY-20), Niki Tsongas (D-MA-3), Juan Vargas (D-CA-51), Nydia M. Velázquez (D-NY-7), Jackie Walorski (R-IN-2), and Frederica Wilson (D-FL-24).

For more information, contact Francesca Fierro O'Reilly, vice president of Advocacy

Graham-Cassidy Bill Fails to Garner Enough Support for Senate Vote

On Sept. 26 Senate Republicans gathered to discuss the plan forward for the latest version of the Graham-Cassidy bill. GOP leadership announced later in the day that a vote would not be held since there were not enough senators supporting passage of the bill.

Republican Senators Susan Collins (R-ME), John McCain (R-AZ), and Rand Paul (R-KY) publicly stated their strong opposition to the bill, along with all of the Democratic senators. As a result, the bill could not garner even a simple majority of the Senate, which was necessary to pass the bill under the streamlined budget reconciliation rules that expired on Sept. 30.

NPA is pleased that the Senate could not muster enough support for the deep Medicaid cuts and per-capita cap funding methodology contained in the bill. Thanks to all of the NPA members who contacted their senators, as your voices helped keep up the pressure.

Going forward, it remains a possibility that the Senate will revisit the issue. NPA understands that many Senate Republicans would like to move away from repeal of the Affordable Care Act (ACA) and focus on tax reform. We will continue to monitor congressional efforts and keep you informed.

For more information, contact Francesca Fierro O'Reilly, vice president of Advocacy.

Post-Election and PACE

NPA has developed a post-election member update to provide information on the key policy issues of concern to PACE organizations.

At-Risk Medically Complex PACE Pilot Development

NPA worked with a group of PACE organizations, consumers and policy organizations to develop a framework for an at-risk medically complex pilot population. The At-Risk Medically Complex Pilot Framework addresses the following components of a pilot for this population:

  • eligibility criteria,
  • service delivery,
  • payment and
  • quality indicators.

NPA and the workgroup members strongly believe that a pilot guided by this framework holds great potential for improving the quality of life and quality of care experienced by individuals who are at risk of needing a nursing home level of care. Through better coordinated care that promotes well-being and slows health decline, the PACE organizations in the pilot can delay the need for nursing home care. For many, this also will delay their need to have their care paid for by state Medicaid programs.

NPA has provided the pilot framework to the Centers for Medicare & Medicaid Services (CMS) and encourages CMS to use its PACE pilot authority to conduct a pilot for the at-risk medically complex population.

NPA Webinar on PACE Pilots

NPA, along with a number of disability community stakeholders, hosted a webinar titled "PACE Pilots: A New Era for Individuals with Disabilities" about the Adapted PACE Protocol on Aug. 24.

The PACE Innovation Act of 2015 provides the Centers for Medicare and Medicaid Innovation (CMMI) the authority to develop PACE pilots for new populations. In anticipation of the pilots, NPA and a number of disability community stakeholders have completed work on the Adapted PACE Protocol, which builds on the current PACE program design and adapts it to address the needs and concerns of younger people with disabilities.

The webinar addressed the potential pilot populations being served under the PACE Innovation Act of 2015, the Adapted PACE Protocol and next steps. Speakers included Peter Fitzgerald, executive vice president of Policy and Strategy at NPA; Esme Grant, of the American Network of Community Options and Resources; Laura Weidner, of the National Multiple Sclerosis Society; and Sarah Meek, of the Lutheran Services in America Disability Network.

You can view the webinar and the accompanying slide presentation.

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PACE Innovation and Growth

NPA works with Congress to promote PACE innovation and growth.

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